Provider Demographics
NPI:1184793267
Name:MCARDLE CULHANE, CHERYL L (LCSW)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:MCARDLE CULHANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11328 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-1248
Mailing Address - Country:US
Mailing Address - Phone:815-988-4396
Mailing Address - Fax:
Practice Address - Street 1:11328 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1248
Practice Address - Country:US
Practice Address - Phone:815-965-1817
Practice Address - Fax:815-637-9261
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490074381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL530520Medicare ID - Type Unspecified